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High-protein/Low-carb diet useful in controlling diabetes

Diabetes type 2 is often associated with obesity (body mass index higher than 30.0 kg per meter squared). At the 16th European Congress on Obesity in Geneva Dr. Neil Mann presented a study of 99 patients. Half were put on a high protein diet, the other half on a high carbohydrate diet and followed for one year with periodic blood tests and examinations by their family doctors. The study population’s age ranged from 30 to 75 years and their body mass index varied from 27 to 40. The hemoglobin A1C level that is a measure of severity of the diabetic condition ranged from 6.5% to 10%.

The high-protein diet was structured so that 30% of calories came from protein, 40% came from carbohydrates and 30% came from fat. With the high-carbohydrate diet 15% of the calories came from protein, 55% from carbs and 30% from fat. In both groups the total calorie intake per day was restricted to 1500 calories and the carbohydrates were given as low glycemic index carbohydrates (less processed). In both groups the diabetes was better controlled with hemoglobin A1C, triglyceride levels and cholesterol levels normalizing. Both groups also showed an equal amount of weight loss that stayed down as long the patients adhered to the diet. However, the high-protein group was able to reduce diabetes pills (metformin) and insulin achieving the same results as the high-carbohydrate group that could not reduce their medications. The conventional approach is to use a low-fat, high-carbohydrate diet along with medication. However, this diet tends to lead to higher triglyceride levels, higher blood sugar levels and a reduction in the good cholesterol (HDL).

Dr. Mann who is a professor and head of the department of nutrition and food science at RMIT University, Melbourne, explained the people get confused when they hear the term high-protein diet as they think of the Atkins diet where the protein component was much higher. The diet that was investigated here is a more natural diet consisting of slightly higher protein and less processed carbohydrates. By containing more fat than in the conventional diabetic diet the patient is not getting hungry and finds it easy to stick to the diet, which leads to weight loss and improvement of the metabolism. Many patients can normalize their blood values and often even get off their diabetic medication (under careful supervision by their treating physician). The physician will address the three components of diabetic control (energy balance, glycemic control, and vascular complications) by recommending to the patient this high-protein/low-carb diet. This likely will replace the conventional approach of using a low-fat, high-carbohydrate diet.

16th European Congress on Obesity, Geneva June 23, 2008

Chronic Kidney Disease Kills

Chronic kidney disease (CKD) has been on the rise for several years and is responsible for premature deaths all over the world. Many different kidney diseases (glomerulonephritis, pyelonephritis, diabetic nephropathy, hypertensive nephropathy etc.) will lead to end stage kidney disease, called chronic kidney disease, and this in turn would require dialysis treatment or a kidney transplant. Often these patients will die prematurely.

Dr. Chi-Pang Wen and collegues from the National Health Research Institutes, Taiwan, have followed a total of 462,293 people with all stages of CKD since 1994. At the end of 2006 there were 14,436 deaths in this population. The two best screening tests to predict deterioration of kidney disease were the flow rate of fluid through the kidneys (medically termed “glomerular filtration rate”) and protein tests of urine. The glomerular filtration rate should stay constant and above a certain cut-off point, and protein should not leak into urine. When the medical researchers started to analyze the results of this study, they found that CKD was affecting about 12% of the general population (the figures are very similar to the US). The patients with CKD had an 83% higher general mortality and had a 100% higher mortality from cardiovascular diseases.

After a 13 year observation period with a median follow-up of 7.5 years 10.3% of the deaths in the entire population were due to CKD. In the low socioeconomic status group this figure was 17.5%. About 40% of the deaths from CKD occurred before the age of 60. Those in the study who had been taking Chinese medicines had a 20% increased risk to develop CKD.

In most countries around the world regular yearly screening of glomerular filtration rates and testing for protein leakage into urine is not done on a large scale. But this is the only way to prevent early kidney disease from developing into chronic kidney disease. Once early kidney disease has been identified, preventative measures like salt restriction, treating diabetes and treating unrecognized high blood pressure etc. can be implemented. In many cases this will prevent the need for dialysis, kidney transplants and death from chronic kidney disease.

Lancet ( 2008), vol. 371, page 2173 to 2182 (June 28, 2008)

Buprenorphine Prevents Relapses For Heroin Addicts

It is a great challenge for persons who are suffering of drug addiction to quit. There is the difficult period of detoxification. Even though there is a lot of support, there will be intense withdrawal symptoms, and every drug free day is a hard won victory. It is a major milestone on the road to recovery to be discharged from a detox program, but the task to remain drug free and abstinent is anything but easy. For this reason it is of utmost importance that support to prevent a relapse is available in the form of counseling, support groups and a maintenance program which involves medication is accessible to the patient.

A standard treatment drug has been naltrexone which helped the recovering addict to remain abstinent. It has been largely used in patients who were recovering from heroin addiction. Dr. Richard Schottenfield from Yale University School of Medicine, New Haven, Ct. and colleagues led a randomized trial to compare the efficacy of the standard drug regimen of naltrexone with the medication Buprenorphine in patients who were in the process of receiving detoxification and drug counseling. A group of patients received placebo (sugar pills that contain no medication.) From the 126 detoxified heroin dependent patients 43 received the standard treatment of naltrexone, 44 received Buprenorphine and 39 took placebo pills.

The researchers found that patients who received Buprenorphine lasted nearly twice as long till they experienced a relapse than those who were on naltrexone and more than twice as long as compared to those who took placebo pills.HIV risk reduction behaviors were significantly reduced in all three groups. Maintenance treatment with Buprenorphine is a significant public health approach to reduce problems that are connected with heroin dependence and can make a difference to the recovering heroin addict on the path of abstinence from the drug.

Lancet (2008) vol.371, pages 2192-2200 and 2150-2151

Have A Cup Of Coffee And Decrease Your Death Risk

Coffee can be good for you, and this is one of the items, which even tastes good! There are some exceptions as discussed in previous articles: more than 2 cups per day can increase the risk for miscarriages in pregnant women. People who are anxious or nervous can find that coffee will aggravate anxiety. Patients with rheumatoid arthritis should also not indulge in the flavorful brew.

Aside from these exceptions researchers have found that coffee consumption can be beneficial. A recent study using the data from 41,736 male and 86,214 female subjects has evaluated data over a follow- up time of 18 years in the male group and 24 years in the female group. The risk of all-cause mortality decreased significantly with increasing coffee consumption in the male as well as in the female group. Men had a relative risk reduction of 20% as compared to their counterparts with the lowest level of coffee consumption. Women with intermediate to high consumption had a relative risk reduction of 10% to 30 % as compared to the group that drank less than 1 cup of coffee per month.

The limit of the study in this case was the self-reported nature of coffee consumption, but the researchers feel that the modest benefit of reduction of all-cause and CVD death warrants further investigation.

June 17, 2008 Annals of Internal Medicine

Genetic Difference Influences Sweet Tooth

Environmental factors and ethnic customs can influence us to have certain likes and dislikes of foods, but researcher Ahmed El-Sohemy has found in his studies that there is also a biological and genetic basis for some of our food preferences. Researchers from the University of Toronto have discovered a genetic difference in people who consume extra sugar in their diet. The specific genetic constellation which the researchers have called GLUT2 does not only work in the pancreas, but it also is responsible for turning on satiety signals in the brain. It seems to have an impaired ability to notice high blood sugar levels that ultimately send “stop eating” signals to the brain. The habit to eat more sweets has been researched in persons with diabetes, but Dr. El-Sohemy does not believe that diabetes is directly connected with gene GLUT2. On the other hand he does not suggest that the presence of the gene should be an excuse to overindulge in sugar high foods. He states that food habits in humans are often connected to the availability of foods: if there is a birthday party and birthday cake, the people with a liking of sweets will be the first to get a slice of cake. On the other hand, if there are no sweets available, they will not make an extra trip to the store just for a piece of cake. The most logical approach is to minimize the availability of foods that are high in sugar, which is especially important for individuals who have GLUT2, the ”sweet tooth gene”, so they are not tempted to overindulge. Here is a link to a short video presentation regarding the sweet tooth gene. Much was learnt from two separate studies that involved 100 older adults on the one hand who were overweight or obese and 587 healthy younger adults who were mostly lean. Foods and beverages that were consumed were carefully recorded. In both investigations blood was drawn for DNA analysis and the presence or absence of the variation of the GLUT2 gene was compared to the food intake data. The older obese group with the variant gene consumed 112 grams of sugar per day versus 86 Grams per day for the non-variant gene group (normal control). The younger population carrying the variant gene consumed 131 Grams of sugar per day, while the non-variant control of young people consumed 115 Grams of sugar per day. This illustrates how genetic influences have an effect on our eating habits and also that younger people ought to be careful that they do not overuse sugar containing foods.

Medical Post Vol 44, No. 16, June 16, 2008: page 19 (based on May issue of Physiological Genomics)